Pre services specialist i
Company Name:
Elliot Hospital
PRE SERVICES SPECIALIST I
Department: PRE SERVICES
Schedule: Days
Shift: Monday - Friday
Hours: 24
Job
Summary:
POSITION
Summary:
To provide superior service excellence and promote the Elliot Experience to all who access the Elliot Health System. Pre-Services Specialists are members of the Patient Access team dedicated to completing patient access workflows related to scheduled patient services for the inpatient, ambulatory, and physician practice settings. Pre-Services Specialists work directly with referring physician offices, payers, and patients to ensure full financial clearance prior to the provision of care.
KEY
Responsibilities:
Follows established department policies to completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the EHS enterprise.
Establishes contact with patients via inbound and outbound calls and accesses department Pre-Registration work queues to pre-register patients for future dates of service.
Verifies insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; documents payer verification responses in designated fields within the registration pathway.
Compares the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contacts the patient and provides guidance for resolution of PCP discrepancies or mismatches.
Validates insurance referral status, if applicable, and communicates with PCP office to obtain referrals.
Validates pre-certification status, if applicable, and communicates with ordering physicians offices to obtain pre-certification information; documents pre-certification status in designated field within the registration pathway.
Provides notification of admission to payers within 24 hours of admission for inpatient stays.
Initiates and completes the Medicare Secondary Payer Questionnaire (MSPQ) via a phone interview with the patient as necessary.
Interprets insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.
Communicates patient financial responsibility amounts and initiates the point of service (POS) collections process.
Identifies patients requiring payment assistance options and facilitates communication between patients and EHS Financial Counselors.
Works collaboratively with all departments/services of the Elliot Health System to ensure that all scheduled patients have undergone financial clearance prior to service.
REQUIRED KNOWLEDGE & SKILLS:
Superior customer service skills and professional etiquette
Strong written and oral communication skills
Attention to detail and ability to multi-task in complex situations
Demonstrated ability to solve problems independently or as part of a team
Knowledge of and compliance with confidentiality guidelines and EHS policies and procedures
Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers
Knowledge of and compliance with regulatory guidelines, such as EMTALA, HIPAA, MSPQ, ABN, and Red Flag
EDUCATION/EXPERIENCE/LICENSURE:
I. Education: High school diploma or equivalent required.
II.
Experience:A minimum of one (1) year healthcare experience in Patient Access registration, pre-registration, or insurance verification or equivalent office / customer service experience preferred.
III. Certification/Licensure: None
IV. Software/Hardware: Computer, telephone, fax machine. EPIC experience preferred.
Elliot Health System is an Equal Opportunity Employer and an Affirmative Action EmployerEstimated Salary: $20 to $28 per hour based on qualifications.
Elliot Hospital
PRE SERVICES SPECIALIST I
Department: PRE SERVICES
Schedule: Days
Shift: Monday - Friday
Hours: 24
Job
Summary:
POSITION
Summary:
To provide superior service excellence and promote the Elliot Experience to all who access the Elliot Health System. Pre-Services Specialists are members of the Patient Access team dedicated to completing patient access workflows related to scheduled patient services for the inpatient, ambulatory, and physician practice settings. Pre-Services Specialists work directly with referring physician offices, payers, and patients to ensure full financial clearance prior to the provision of care.
KEY
Responsibilities:
Follows established department policies to completely and accurately pre-register patients, verify insurance eligibility and benefits, validate pre-certification or referral status, and collect patient responsibility amounts for services provided throughout the EHS enterprise.
Establishes contact with patients via inbound and outbound calls and accesses department Pre-Registration work queues to pre-register patients for future dates of service.
Verifies insurance eligibility and benefits by utilizing integrated real-time eligibility tool, payer websites, and telephone calls to payers; documents payer verification responses in designated fields within the registration pathway.
Compares the primary care physician (PCP) information indicated by the insurance verification response to the location of the primary care office visit, if applicable; contacts the patient and provides guidance for resolution of PCP discrepancies or mismatches.
Validates insurance referral status, if applicable, and communicates with PCP office to obtain referrals.
Validates pre-certification status, if applicable, and communicates with ordering physicians offices to obtain pre-certification information; documents pre-certification status in designated field within the registration pathway.
Provides notification of admission to payers within 24 hours of admission for inpatient stays.
Initiates and completes the Medicare Secondary Payer Questionnaire (MSPQ) via a phone interview with the patient as necessary.
Interprets insurance verification information to estimate patient financial responsibility amounts for scheduled services and inpatient stays.
Communicates patient financial responsibility amounts and initiates the point of service (POS) collections process.
Identifies patients requiring payment assistance options and facilitates communication between patients and EHS Financial Counselors.
Works collaboratively with all departments/services of the Elliot Health System to ensure that all scheduled patients have undergone financial clearance prior to service.
REQUIRED KNOWLEDGE & SKILLS:
Superior customer service skills and professional etiquette
Strong written and oral communication skills
Attention to detail and ability to multi-task in complex situations
Demonstrated ability to solve problems independently or as part of a team
Knowledge of and compliance with confidentiality guidelines and EHS policies and procedures
Knowledge of insurance requirements and guidelines for Governmental and non-Governmental carriers
Knowledge of and compliance with regulatory guidelines, such as EMTALA, HIPAA, MSPQ, ABN, and Red Flag
EDUCATION/EXPERIENCE/LICENSURE:
I. Education: High school diploma or equivalent required.
II.
Experience:A minimum of one (1) year healthcare experience in Patient Access registration, pre-registration, or insurance verification or equivalent office / customer service experience preferred.
III. Certification/Licensure: None
IV. Software/Hardware: Computer, telephone, fax machine. EPIC experience preferred.
Elliot Health System is an Equal Opportunity Employer and an Affirmative Action EmployerEstimated Salary: $20 to $28 per hour based on qualifications.
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